Epidemiology of Tobacco Use Among American Indian/Alaska Native Adolescents: Findings From a National Sample

Background and Purpose: American Indian or Alaska Native (AI/AN hereafter) adolescents appear to have higher rates of tobacco use overall than other ethnic/racial groups although the prevalence rates vary greatly by region and culture (USDHHS, 2008). High rates of tobacco use increase the risk for the two leading causes of death--heart disease and cancer--among AI/AN adults (CDC, 2003). Previous studies have contributed to the design of smoking cessation and prevention strategies for AI/AN youths. Still, there are gaps in the literature regarding prevalence rates of different types of tobacco use and relative impacts of multiple variables on different types of tobacco use in this population. Using a nationally representative sample, this study examines prevalence rates and predictors of different types of adolescent tobacco use (i.e., cigarettes, menthol cigarettes, smokeless tobacco, cigars, pipes, and polytobacco use). Methods: Using data from the 2006 National Youth Tobacco Survey, 301 AI/AN adolescents in grades 6 through 12 were selected (male, 55.5% and mean age=13.9 [SD=2.1]). The nationally representative self-administered mailing survey data are well-suited for this study in that they include information about the different types of tobacco and individual, familial and social predictors. Weighted percentages were calculated for prevalence rates of different tobacco use; and multiple logistic regression analyses with a weighted variable were performed to identify determinants of the different types of tobacco use. Results: Findings revealed that more than half of the youths(54%) used any tobacco product in life. Specifically, the majority used cigarettes(53%); one in nine(12%) used menthol cigarettes; one in six(16%) used smokeless tobacco; one in four(23%) used cigars; one in nine(12%) used pipes; one in six(17%) used two or more tobacco products. High school students had significantly higher rates of all types of tobacco use than middle school students while the prevalence rates did not differ by gender. Multivariate analyses showed that age(OR=1.3,95%CI:1.1,1.5), family members' smoking(OR=1.9,95%CI:1.0,3.4), refuse tobacco from best friends(OR=0.4, 95%CI:0.2,0.5), number of days absent from school(OR=1.5,95%CI:1.1,1.9), and receptivity to tobacco marketing(OR=1.5,95%CI:1.0,2.1) predicted any tobacco use (vs. nonuse). Of these predictors, refuse tobacco from best friends also predicted cigarette-only smoking(OR=0.4,95%CI:0.2,0.8), any two product use (OR=0.3,95%CI:0.1,0.6) and any three or more product use (OR=0.2,95%CI:0.1,0.4); and number of days absent from school(OR=2.6,95%CI:1.4,4.8) and receptivity to tobacco marketing(OR=2.7,95%CI:1.3,5.4) predicted any three or more product use. No significant models for predicting the other types of tobacco use were found. Conclusions and Implications: This study confirmed that AI/AN youth have higher rates of tobacco use than general population of the same age (54% vs. 41%). The study suggests that encouraging youths to refuse tobacco from best friends may be an important component of smoking cessation and prevention programs. In addition, programs should focus on educating adolescents about how to handle family members' smoking, helping youth stay in school particularly for polytobacco users, and providing information about how the tobacco industry has manipulated the public. Programs may be more effective and efficacious among middle school students than among high school students.